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Mental Capacity Assessment

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Best Interest Decisions in everyday practice: Part 1

A Best Interest Decision is the step that is taken if a person is found to lack mental capacity for a specific decision at a specific time. It is not a single action, but rather a dynamic process that aims to uphold the individual’s rights, keeping their thoughts, feelings, beliefs and values at its heart, while also consulting with all relevant parties to weigh up the viable options.

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Loneliness and isolation: Elderly woman with head resting on her arms looking out of window.

Mental Capacity and Insight

The term ‘insight’ is often used by health and care professionals. For example, it may be recorded that a person ‘lacks insight’ into their toileting personal care needs. By which, the professional may be seeking to state (in a diplomatic way) that the person does not recognise when they have been incontinent.

The term is also used in other contexts in the care setting as well. For example, that a person may ‘lack insight’ into their mobility as a result of their dementia. By which the professional may be indicating that the individual’s falls are due to their impaired short-term memory and orientation, and that they are not able to process that their movements have deteriorated due to their Parkinson’s-related dementia which is causing them to have increased falls.

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Elderly man walking through city using two walking sticks to support his mobility.

What is ‘salient information’?

When conducting a Mental Capacity Assessment it is vital to understand the salient information relevant to this case. Put simply, ‘salient information’ is the relevant information that is required in order for the relevant person to be able to demonstrate capacity for the specific decision being addressed.

To help illustrate this point, we have two case studies that consider two separate decisions: whether to install bed rails, and whether to smoke.

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Woman deep in thought during assessment.

COPPA: Masterclass in Executive Dysfunction & Mental Capacity

We recently had the privilege to attend a stimulating event exploring the role of executive dysfunction and mental capacity. The afternoon was hosted by CoPPA North West and Pennine Care NHS Foundation and featured speakers from across the legal and medical professions, including Judge Simon Burrows, Barristers Rebecca Clark and Neil Allen, and Consultant Psychiatrists Dr Cathy Symonds, Dr Ade Akinola and Dr Samuel Wintrip.  

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Contact meeting between relevant person and their representative

How many stages are there in a Mental Capacity Assessment?

According to the Mental Capacity Act (2005), a Mental Capacity Assessment is made up of two stages, functional and diagnostic. It has therefore been referred to as the ‘two-stage’ test. However, a quick browse online, alongside discussion with different professionals, reveals quite a bit of misunderstanding around how many stages there are and when these stages apply. This is perhaps due to the inconsistent way that assessments are referred to by certain institutions and professional bodies. There also seems to be some confusion between the four steps of the functional stage of an assessment, and the two stages of the overall assessment.

Clearly, terminology is important, and we should make efforts to ensure we are always using the correct terms.

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Retrospective Mental Capacity Assessments

A standard mental capacity assessment (also known as the two-stage test) is usually carried out for a specific decision at a specific time. It is completed prior to the decision being made if there is either a ‘reasonable belief’ that an individual may lack capacity, or to reduce the risk of someone challenging the person’s capacity to make the decision at some point in the future.

Meanwhile, a retrospective mental capacity assessment refers to a traditional assessment of capacity for a specific decision, but for a decision made historically. Examples might include a Lasting Power of Attorney submission signed and submitted the previous month, or a financial gift made to a family member or friend several years in the past.

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